FEEDING ROUTES
Nasal Insertion:
Contraindications
Basal skull fracture
Nasal injury
Coagulopathy
Sinusitis
NASOENTERIC
Nasogastric (NG)
Nasoduodenal (ND)
ENTEROSTOMIES
Gastrostomy
Gastrojejunostomy
Jejunostomy
Potential Complications
Skin irritation (leak)
Wound infection
Gastric outlet obstruction
Leakage gastric contents
(intraperitoneal)
Gastrocutaneous fistula
ENTRIFLEX FEEDING TUBE
12 Fr; 43 in
(110 cm)
Polyurethane
Radiopaque
Dual port flow- through stylet
Closed - end
Tungsten tip
HYDROMER coated lumen
(water activated)
CHOOSING A FEEDING ROUTE & PLACEMENT METHOD
Gastric
NO
Contraindication to gastric feeding?
YES
Postpyloric
GASTRIC FEEDING: CONTRAINDICATIONS
ƒ Gastric residual volume (GRV) > 250 ml despite 4 doses IV metoclopramide.
ƒ Chronic/acute GERD
ƒ Aspiration risk (i.e. nursed prone/ supine).
NO
Short term:
Bedside ND
Long term:
Endoscopic or fluoroscopic gastrojejunostomy
Pending abdominal surgery?
YES
Short term:
Intra-op ND
Long term:
Surgical jejunostomy or gastrojejunostomy
DUODENUM
1D) 1 st section
2D) 2 nd section
3D) 3 rd section
4D) 4 th section
J) Jejunum
1D
2D
3D
ND TUBE TIP POSITION
4D
J
ND INDICATIONS
Gastric stasis
Aspiration risk
Acute pancreatitis
Developed by: J. Greenwood, RD.
Update : 1/5/2009
Reviewed by : Members of the ICU QI/QA Committee.
Approved by : Dr V. Dhingra, ICU Medical Director.

HOW TO SECURE A NASAL TUBE
1) Wipe nose with alcohol swab to remove oil.
2) Prepare nose with a barrier/adhesive product.
3) Prepare silk tape.
4) Place tape on nose (a); pinch (tent) tape to reduce contact pressure on nostril.
5) Wrap tape legs (b) along a 8 cm (3 in) length of tube.
6) Secure tape on nose with 2 nd piece of tape (c)
7) Check tube security daily (tug tube).
8) Replace tape as indicated. a b c b a c
HOW TO SECURE AN ORAL TUBE TO AN ENDOTRACHEAL TUBE
MEDICATION
DELIVERY
For patients with an NG AND ND tube, use the NG for meds unless contraindicated
(GRV > 250 mL).
NO
NG SALEM SUMP vs. NG ENTRIFLEX
Tolerating gastric feeds?
(Tolerance: at goal rate x 5 days; gastric residual volumes consistently <250 mL while not receiving a prokinetic agent).
YES
End otra che al t ube
Su mp
En trif lex
All operative procedure(s) (requires pre-op mechanical decompression) completed; pt not receiving hourly IV narcotic analgesic agent(s)?
YES
NO
#18
NG Salem Sump
#12
NG Entriflex
1) Cover a 6 in (15 cm) length of cloth tape with clear plastic tape.
2) Fold the cloth/plastic tape around the circumference of the oral endotracheal tube, the sump, and the Entriflex tube. Press the tape firmly between each tube.
ASSESSING GASTRIC RESIDUAL VOLUMES (GRV):
OG Sump only: Check GRV q4h; refeed as per protocol.
ND or NG Entriflex only: Do not check GRV.
O G Sump with ND Entriflex : Check GRV (Sump) q4h; discard.
HOW TO CLEAR AN OCCLUDED ENTRIFLEX TUBE
TUBE OCCLUSION
PREVENTION
Flush tube with 20 mL water q4h as well as whenever feeds are held and prior to and after medication delivery. b a
Technique: Insert a white ribbed connector fitted with a red IV cap into the side port of the tube (a). Insert a water-filled 5 mL syringe fitted with a white ribbed connector into the main port (b). Pump syringe repeatedly.
If ineffective, insert a slurry filled 5mL syringe (Slurry: 1 crushed pancreatic enzyme tab; 1 crushed sodium bicarb tab; 5 ml water) into main port.
Pump syringe repeatedly. If ineffective, leave slurry in tube for 2 - 4 hrs
(or overnight). Note: Remove tube only after several serious attempts.